title: Favorable strategy for the ostial lesion of the left anterior descending coronary artery: influence on narrowing of circumflex coronary artery.
abstract: We examined the effectiveness of Palmaz-Schatz (P-S) stent and directional coronary atherectomy (DCA) in ostial lesions of left anterior descending arteries (LAD). The P-S stent was implanted in 11 cases at LAD ostial lesions, and DCA was performed in 13 cases. Percent stenosis and vessel diameter at the target site and the ostium of the circumflex coronary artery (LCX) were measured before and after the procedure. The initial success rate was 100% in both groups. No major complication occurred. LAD ostial lesions were improved from 81.3+/-3.4% to -8.1+/-5.7% by P-S stent and from 82.8+/-2.6% to -2.7+/-3.9% by DCA. LCX ostial vessel diameter was not changed by DCA (from 3.0+/-0.2 mm to 3.1+/-0.3 mm); however, it was significantly decreased by P-S stent (from 2.9+/-0.2 mm to 2.6+/-0.2 mm, P < 0.01). When the angle of LAD and LCX was < or = 80 degrees from the view of RAO 30 degrees and Caudal 30 degrees, the LCX ostium was significantly narrowed by stenting at LAD ostium (P < 0.01). These findings indicate that both the P-S stent and DCA are effective and safe therapies for LAD ostial lesions in cases with LAD-LCX angle > 80 degrees. In cases with LAD-LCX angle < or = 80 degrees, however, DCA is a favored therapy rather than P-S stenting to avoid narrowing of the LCX ostium.
authors.affiliation: Cardiopulmonary Division, Keio University, Tokyo, Japan. asakura@mc.med.keio.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Asakaura
authors.forename: S
authors.initials: S
authors.lastname: Takagi
authors.forename: S
authors.initials: S
authors.lastname: Ishikawa
authors.forename: K
authors.initials: K
authors.lastname: Asakura
authors.forename: K
authors.initials: K
authors.lastname: Sueyoshi
authors.forename: M
authors.initials: M
authors.lastname: Sakamoto
authors.forename: S
authors.initials: S
authors.lastname: Takatsuki
authors.forename: T
authors.initials: T
authors.lastname: Oda
authors.forename: M
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Y
authors.initials: Y
authors.lastname: Furukawa
authors.forename: K
authors.initials: K
authors.lastname: Oyamada
authors.forename: S
authors.initials: S
authors.lastname: Iwanaga
authors.forename: S
authors.initials: S
authors.lastname: Ogawa
authors.forename: T
authors.initials: T
authors.lastname: Hinohara
mesh_terms: D017225:Atherectomy, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents